AB0206 DIFFICULT TO TREAT RHEUMATOID ARTHRITIS (D2T-RA) IN THE REAL LIFE SETTING IS INDEPENDENT OF AUTOANTIBODY STATUS OR GENDER BUT IS ASSOCIATED WITH OBESITY, FIBROMYALGIA, AND EROSIONS AT DIAGNOSIS.
Authors: N. Luciano, E. Barone, E. Brunetta, M. De Santis, A. Ceribelli, M. Caprioli, G. M. Guidelli, A. Sonaglia, D. Renna, N. Isailovic, C. Selmi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite the growing number of available drugs for Rheumatoid Arthritis (RA) and the significant improvement in disease management, numerous patients continue to fail multiple lines of DMARDs. The EULAR definition of Difficult to Treat Rheumatoid Arthritis (D2T-RA) is based on 3 criteria: the failure of 2 or more b/tsDMARDs with different mechanism of action, the persistence of signs of active/progressive disease despite treatments, and the clinician or patients' perception of a "problematic" management. There is limited evidence on the prevalence of D2T-RA in real life and the factors associated with this entity. <h3>Objectives</h3> To characterize D2R-RA cases in a real-life cohort of patients. <h3>Methods</h3> We retrospectively collected data of patients with RA fulfilling the ACR/EULAR 2010 classification criteria who attended our outpatient clinics between January 2019 and November 2022. The comparison between D2T-RA and other patients was performed using T-, Mann-Whitney and Chi-Square tests while logistic regression models analyzed the impact of principal clinical features and comorbidities on outcome variable, adjusted for confounders. <h3>Results</h3> Eighty-seven/400 (21%) patients enrolled met the DT2-RA criteria. No significant differences were found in median age (no-D2T 62±12 vs. D2T 64±15, p= 0.6), median disease duration (no-D2T 8±9 vs. D2T 12±10 years, p=0.9) and gender (female 77%, p=0.9). D2T-RA had similar autoantibody profile, prevalence of interstitial lung disease, C-reactive protein levels at diagnosis, number of tender and swollen joints at diagnosis) and major comorbidities (hypertension, dyslipidemia, COPD, depression, autoimmune thyroiditis). At univariate D2T-RA correlated, without reaching statistical significance, with diabetes (p=0.055), a previous history of major cardiovascular events (p=0.071), previous or current history of smoking (p=0.081) and GERD (p=0.079). Of note, D2T-RA significantly correlated with fibromyalgia (p=0.004), previous surgical intervention to treat RA (p=0.01), peripheral arteriopathy (p=0.035), obesity (p=0.023) and evidence of erosions at diagnosis (p=0.045). The multivariate analysis confirmed the correlations between D2T-RA and baseline erosions (p=0.034, OR 2.23 IC 1.06-4.69), obesity (p=0.041, OR 2.05 IC 1.03-4.09) and fibromyalgia (p=0.004, OR 3.28 IC 1.47-7.32) regardless of age and gender or, in the case of fibromyalgia, obesity. <h3>Conclusion</h3> Our data support the importance of comorbidities to determine D2T-RA which is not influenced by the autoantibody profile. In particular, fibromyalgia and obesity likely increase the probability of a DMARDs multi-failure. Data on baseline erosions and a previous history of surgery possibly suggest that a better timing of intervention with earlier treatments may reduce the risk of D2T-RA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Nicoletta Luciano Speakers bureau: Abbvie, BMS, Eli-Lilly, Janssen, Consultant of: Galapagos, Elisa Barone: None declared, Enrico Brunetta: None declared, Maria De Santis: None declared, Angela Ceribelli: None declared, Marta Caprioli: None declared, Giacomo Maria Guidelli Speakers bureau: Janssen, Lilly, Novartis, Abbvie, Galapagos, Consultant of: Janssen, Arianna Sonaglia: None declared, Daniela Renna Speakers bureau: Janssen, Natasa Isailovic: None declared, Carlo Selmi Speakers bureau: AbbVie, Amgen, Alfa-Wassermann, Biogen, Eli-Lilly, Galapagos, Janssen, Novartis, Pfizer, SOBI, Consultant of: AbbVie, Amgen, Alfa-Wassermann, Biogen, Eli-Lilly, Galapagos, Janssen, Novartis, Pfizer, SOBI, Grant/research support from: AbbVie, Amgen, Pfizer.